HB 320: The Good News and the Bad News for NC Medicaid Providers

If you have been following my blog, then you know that I have been vehemently opposing House Bill 320. Well, the bad news is that HB 320 passed its 2nd reading today. The good news is that HB 320 has morphed from a MCO-sovereign Bill into a more reasonable Bill.

Prior to the strike outs, HB 320 allowed

108D-10: The MCOs to conduct closed networks (i.e., disallowing providers into the networks);

108D-11: The MCOs to select the providers allowed in the network;

108D-13: The MCOs to conduct unannounced on-site visits, post-payment reviews and any other allowable function of Program Integrity;

I echo Linda’s comment. Thank you so much for your blog! I have to wonder what this means. It almost looks as if under this bill the MCO’s aren’t MCO’s anymore. I mean if they can’t operate a closed network, pick and choose who can participate, put people on pre-payment and post-payment reviews like they’ve been doing, they’ll really loose much of the power that they currently exercise as MCO’s…which is a good thing!

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Knicole C. Emanuel

Knicole C. Emanuel is an attorney at Potomac Law Group in Raleigh, NC where she concentrates on Medicare and Medicaid regulatory compliance litigation. See legal disclaimer @ "About Knicole."
Follow her on Twitter at @medicaidlawnc.